Dr Delanghe, Waterloo Chiropractor

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training and performance

I have written many times(1234)  about the importance of ingesting carbohydrates during a race (if it’s long enough).

I’ve also discussed how taking in other sources of fuel, like protein, is not the best move due to it triggering an increased risk of GI distress. The reason: in part, protein is not absorbed and metabolized as quickly as carbohydrates. Delayed gastric emptying results in water diffusing into your guts and increasing the odds of needing to take a PB-killing washroom break! iron sources

One thing I have heard in response to this tip from patients and athletes at H+P is that IF one is able to handle protein from a GI standpoint, is it worth experimenting with on top of carbohydrates as a fuel source? Is there an additional benefit to taking in protein during a race if it doesn’t bother your stomach? That is what we’ll be looking at with this article.

CLICK HERE to read the rest in the RunWaterloo magazine!

TFL

What is it?!

Overuse injury associated with pain on the outside (lateral) part of the knee

Anatomy

The ITB is a band or sheath of fibrous connective tissue that surrounds the muscles on the outside of the thigh and crosses both the hip and knee joint. It originates from the tensor fascia latae (TFL) and gluteus maximus muscles and then continues down the femur (thigh bone) where it attaches to both the femur and tibia (shin bone) on several bony landmarks.

The function of the IT band is to stabilize the hip and knee as well as limit hip adduction (leg moving towards the midline) and internal rotation of the knee.

Epidemiology and Risk Factors

The knee is the most commonly injured area in runners – accounting for 25-42% of all running injuries. ITBs is the second most common knee injury for runners with patellofemoral pain syndrome being first.

ITBSigns/Symptoms

Runners usually have no exact history of trauma and find that the pain comes on gradually over the outside of the knee during a run. The pain usually appears within a few km of a run and increases in intensity. That same area can also be tender to touch.

Pathophysiology/Etiology

There are a couple theories on the pathophysiology of ITBs.

Some researchers believe that ITB inflammation is a result of excessive friction between the ITB and the boney prominences which occur when the ITB slides over the boney structure and causing inflammation during repetitive movements such as running. Others have argued that rather than the ITB band causing excessive friction, the inflammation is caused by the ITB compressing an area of highly innervated fatty tissue between the IT band and boney prominence

Contributing Factors to Developing ITB Syndrome

The most common factor in developing ITBs is an increase in exercise intensity through mileage, hill training or speed work.

Other reported possible causes which may increase tension in the ITB by altering hip and knee angles include:

  • Downhill running
  • Wearing old shoes
  • Always running on same side of road
  • Leg length discrepancies
  • Excessive pronation of the foot (foot rolling inward)
  • Tight ITB
  • Weakness of glute medius muscle

ITBs and Running Biomechanics

It has been suggested that injuries can manifest as a result of an increase in exercise intensity beyond a threshold level, combined with certain intrinsic factors in athletes.

A recent systematic review looked at biomechanical variables and investigated whether distance runners who suffer from or develop ITBs have different biomechanics than runners who do not develop ITBs.

The evidence shows that it is unlikely that abnormal biomechanics at the foot or shin bone can contribute to increasing tension of the ITB.

The results suggest more is happening at the hip and knee. Runners who eventually develop ITBs have more internal rotation at the knee and greater glut medhip adduction angles during the stance phase of running (when the foot is in contact with the ground) compared to healthy controls.

Some researchers have found that this internal rotation of the knee is due more to an externally rotated femur (thigh bone rotated outside) and suggests this may be due to insufficient activity in the medial rotators of the hip (gluteus medius, gluteus minimus, TFL).

As for muscle strength and endurance, there is currently no evidence to suggest that reduced muscle strength plays a role in ITBs. However, the research is limited because many of the trials give inaccurate impressions of a muscle’s functional strength. Future research is needed to look at the timing of muscle action rather than the magnitude of strength.

Research also suggests that runners with current ITBs tend to have more trunk flexion than healthy controls. It is uncertain whether the increased trunk flexion is due to a tight ITB or if the ITB becomes tight as a consequence of the flexed trunk (aka: the torso leaning forward)

How do we treat it!?

Stay tuned to my next article on the latest evidence for treating and managing ITBs!

References:

Foch et la. Associations b/n IT band injury status and running biomechanics in women. Gait & Posture. 2014.

Louw & Deary. The biomechanical variables involved in the aetiology of iliotibial band syndrome in distance runners – a SR. Physical Therapy in Sport. 2014

iron sources

When it comes to performance, there’s no doubt that nutrition plays a significant role. In the past, I’ve really focused on acute nutrition: what you can do directly before or during your run to be faster (i.e. here).

training and performance

An area I have neglected to focus on is what you should be doing from a nutritional standpoint on an on-going basis to stay healthy and perform at your best. One key area that I see as a recurring problem in my practice and athletes around me is iron deficiency anemia.

Iron has a number of roles in the human body. The most important function is how it is incorporated into hemoglobin and myglobin to facilitate oxygen transportation. If these proteins decline, our ability to transport oxygen to our working muscles also drops, and performance plummets along with it (such as here and here).

CLICK HERE to read more in the RW Magazine

training and performance

Well, it’s safe to say that the hot summer days of running are here! With many big races on the horizon, including the Waterloo Classic, it’s important make sure we do our best to prepare for the additional challenge heat provides.

gregIt’s a topic I wrote about briefly in the past, but this week I wanted to take a closer look at things. Two strategies I discussed before were (1) getting acclimated to the heat and (2) pre-cooling.

Both of these strategies make sense logically.  If you practice running in the heat, your body will be better equipped to handle it. In the case of pre-cooling, if you start with a cooler body temperature, then there is more wiggle room before your body really has to make the push to cool off. But what does the research show, and how well does each strategy work?

Click HERE to read the rest in the RW Magazine.

I’ve written a few times (1, 2, 3, 4) before about how important it is to ingest carbs while racing a distance that takes over ~40-60mins to enhance performance. There still seems to be some resistance to doing this; some of it is fueled by pseudoscience, but some is fueled by the very legitimate concern that ingesting 30-60g of glucose/hour will cause GI distress and potentially an even more detrimental impact on performance.

There’s no doubt, GI distress is often caused by factors other than the carbs ingested during the race (such as ingesting slowly absorbed, slowly metabolized fat, protein or fibre in close proximity to or during a race). So before trying to fix your carb situation, first make sure that it is indeed your problem.shutterstock_335916845

Training the Gut

So how do we train the gut?  And does it work?  CLICK HERE to read my latest in the Run Waterloo Magazine. 

glut med

Let’s target the hip abductor muscles! In my last article I discussed the importance of core strength and control to stabilize our trunk when we run – specifically the importance of the hip abductor muscles.

To refresh, the hip abductors help to bring the leg to the outside of our midline to counteract the moment of force where our leg naturally wants to move toward the midline each time our foot hits the ground.

We have several hip abductor muscles in our body, the majority of them are in our butt muscles! Gluteus medius (Gmglut meded), gluteus maximus (GMax), gluteus minimus (GMin) and TFL (tensor fascia latae). The focus of this article is going to be on the gluteus medius because of its important role in stabilizing the pelvis.

Why do the gluteal muscles become weak? Most of us spend our days sitting and therefore develop weak gluteal muscles making it harder to recruit them during exercise. This can lead to improper use and poor muscle patterning of other muscles to try to compensate for a weak GMed which may increase risk of injury somewhere down the road.

Using techniques to help isolate these muscles can increase their activation and ultimately improve performance. So, how do we target these muscles? A few electromyographic (EMG) studies can help us out!

Study #1: One leg vs. two legs for Gmed activation 

This study used EMG signal amplitude to measure GMed activation in 5 different weight-bearing exercises; double leg stance, single leg (SL) stance, single leg squat, single leg stance on a cushion, and single leg squat on a cushion, where the cushion was an unstable surface underneath the foot to make the exercise more difficult.

To no surprise, the results showed that a SL stance placed higher demands on the GMed than double leg stance and SL squats are more demanding than SL stance. As for the SL exercises on the cushion; the GMed muscle was activated more, but not significantly more than on flat ground.

Study #2: How do we activate Gmed even more?

This study used EMG signals to measure muscle activation patterns of the GMed (among 3 other hip muscles) during 5 unilateral weight-bearing exercises as shown here:
picss

They compared the level of activation to the subject’s maximal voluntary contraction. The EMG signal amplitude had to be between 40-60% of the maximal voluntary contraction to have sufficient intensity for strengthening.

Of the 5 exercises, the results for the GMed showed the highest amount of activation during the wall squat! The next exercises for activation were as follows: forward step-up, lateral step-up, backward step-up and then mini squat. The authors suggested that these exercises may be used as progression exercises towards the wall squat.

TFLStudy #3: What happens when the gluts are weak?

The last article looked at hip abductor muscle activity during resisted side-stepping exercises in either a squatted or standing position. They found that both the GMax and GMed had greater muscle activity during the squatted position than the upright posture. By being in this squatted position, the TFL muscle is less active which means the gluteal muscles should, in theory, be more active. This is important because if the gluteal muscles are weak, the
TFL will compensate which may lead to further underuse and weakening of the gluteal muscles.

Practical Applications

Here are a few key take home points for activating the Gmed to help enhance our running:

  • The GMed plays an important role in stabilizing the pelvis/hip joint during weight-bearing
  • GMed activation is greater when the base of support is less ie: during a side bridge, unilateral squat and lateral step up
  • Some key exercises to get the most activation from the GMed:
    • Single Leg Stance
    • Single Leg Wall Squats
    • Forward Step Ups
    • Lateral Step Ups
    • Side Steps with a resistance band around the knees/ankle (aka: Monster Walks)

And does strengthening GMed actually help to prevent injuries?  As always, the answer is that it depends, but check out this article  from Dr. Delanghe exploring how GMed strength work can decrease injury-causing variability of motion at the knee.

Happy strengthening!

vitc

Last week I spent most of the week with a mild head cold. Nothing crazy, but enough to motivate me to review my old imtraining-and-performancemunology notes yet again to relearn what I already know (it’s always fun picturing the T-cells destroying the bad stuff). Times like these also motivate me to relearn other things, like how nothing gets rid of a cold other than some basics including: sufficient rest, fluids, stress management and a good diet.

Sometimes when I’m sick, I’ll also scan the literature for new research on the common cold. Usually it’s more of the same: sleep deprivation triggers a depression in immune function, more research is needed to show if supplement X helps, excessive exercise causes a depression in immune function while light exercise may help, and so on.

However, in today’s search, I came across something new that may help us cope with the common cold. The only downside is that this new information applies to a small subset of the population. It fact it’s so specific, it’s almost not worth mentioning and learning…other than the fact that the specific subset I’m referring to is exactly who we are: athletes to train vigorously in cold weather!

What does the science say?

In general, it’s has been proven time and time again that popping vitamins does not help to speed up the recovery associated with the common cold if you are already sick. Long-term supplementation also does not help to prevent the common cold. There is some research suggesting that long term supplementation may reduce the duration of the cold, but that always sounded like a lot of effort and money for a marginal improvement on something
that rarely happens.

So I had long given up on vitamin C. Maintain a healthy diet rich and fruits and vegetables, and that was all I needed in my mind (if I achieve said goal).

Continue reading HERE in the WRS Magazine 

Custom Orthotics

Last month I wrote about how much of a difference light shoes make. In summary, the study I referenced showed losing 100g/shoe will result in just under a 1% improvement in running economy (RE) as long as all other features remain equal.

At Health & Performance, this article generated a lot of good questiontraining-and-performances. The main ones revolved around if it was good to race in the LIGHTEST shoe possible.

In response, I discussed the importance of features such as cushioning providing a boost in RE. Utilizing a shoe that completely lacks cushioning will provide a boost from lost weight, but this change will be at the expense of the spring-like action from that missing cushioning.

Where is the perfect balance?

Once I explained this, the next question became: Where is the perfect balance? How much weight in cushioning is worth it, and just how much of a boost does it provide?

My easy answer was/is to go with a lightly cushioned racing shoe that feels comfortable, and to not worry about the rest. My favourite is the New Balance 1400, which comes in at just over 200g/shoe, but does have some cushioning. The cost of that 200g, I assumed, would be more than offset with the benefits that the 200g provided. That being said, in a world where we strive to be pro-science, evidence-based and anti-fake news, I wanted to dig a little deeper to provide a more clear and proven answer.

What is light enough?

CLICK HERE to read the rest in the RW Magazine

shutterstock_290395721

When race day comes around, it’s always nice to have little things that you can do to run faster without actually having to be more fit. I think for most of us, it’s logical that if our shoes are substantially lighter, we’re going to require less oxygen to run at a given pace.training and performance

However, what doesn’t seem as clear is whether all the effort we put in to losing very small amounts of mass (like 100g) predictably improves our running economy (how efficiently we translate the oxygen we bring in into forward movement).

Taking 2lbs off our shoes will clearly be great for our running economy, but is it worth it to strip down to a flat vs. a light training shoe? And if so, how “worth it” is it?

CLICK HERE to read the rest in the RunWaterloo Magazine

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